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Updated version of Rusbridge syringomyelia document

Clare Rusbridge, IMHO the leading researcher/neurologist into syringomyelia in cavaliers, has a new version of her widely-used syringomyelia information document which I've posted into the FAQs with Clare's permission (to replace the previous version). It is here: http://cavaliertalk.com/phpBB2/viewtopic.php?t=22

Key changes in the updated version:

*** She now clarifies what she means when she says upward of 50% of cavaliers she is screening by MRI are 'affected' -- which can mean they have EITHER the skull malformation that could go on to cause SM, OR the malformation plus SM itself:

This condition occurs in many small breeds but is common in the cavalier King Charles spaniel (CKCS) (conservative estimates at least 50% of the breed have a degree of occipital hypoplasia [the skull malformation] although only a proportion are severe enough to have syringomyelia).

*** She has added furosemide/frusemide (commonly known as Lasix, which cavalier owners may recognise as a key drug used to treat MVD) to the list of potentially helpful medications that can reduce the pressure of cerebrospinal fluid, which in turn can help inhibit the further development of the syrinxes (fluid pockets in the spinal cord) that give syringomyelia its name. Frusimide, which has few side effects even with long-term use, is widely prescribed by UK neurologist G. Skerritt but to date only be a few others:

Drugs which reduce CSF production
Proton pump inhibitors such as omeprazole (Losec or Prilosec) can inhibit cerebrospinal fluid formation and therefore may be valuable; clinical data on their use and effectiveness for SM is currently lacking. This drug is unlikely to be useful in the long term as therapy longer than 8 weeks duration is not recommended as this may increase the risk for stomach cancer. Carbonic anhydrase inhibitors such as acetazolamide (Diamox; Lederle laboratories) also decrease CSF flow and may also be helpful in treating syringomyelia although adverse effects of abdominal pain, lethargy and weakness may limit long term use. Furosemide also decreases intracranial pressure and therefore could be useful in the treatment of syringomyelia. The mechanism of action is unknown and may just be due to diuresis and reduction in blood volume
At present the usefulness of omeprazole, acetazolamide and furosemide for treating syringomyelia is unknown.

Note that she gives recommended dosages for immediate treatment of pain/inflammation in affected cavaliers in this document. If you have a cavalier that is in pain and you suspect may have SM, print Clare's document out as well as mine in the Health section or the FAQs on SM symtpoms and take them to your vet. If your vet believes your cavalier may be showing signs of SM, s/he can at least prescribe basic pain-relieving treatment (steroids -- prednisalone; and neurontin -- generic name gabapentin) which will help stabilise the dog and make it much more comfortable until it can be seen by a neurologist.

Anyone who has not considered donating cavalier blood for the major global research initiative outlined in Clare's document -- please have a read through and understand that YOU AND YOUR CAVALIER CAN MAKE A SIGNIFICANT DIFFERENCE in helping cavaliers and the treatment of several debilitating genetic conditions by donating blood. The blood is used for genetic research into SM, MVD, epilepsy and other conditions and is the single most valuable resource to researchers right now. Cavalier owners in the US, Canada and Europe can all contribute. More detailed info is in Clare's document and attached at the end of the document. If you have had this in the back of your mind, and you care about the control and eventual eradication of these terrible conditions in the breed, think about making an appointment with your vet to gather either DNA or blood. Taking the blood samples only requires about 5 to 10 minutes and ALL cavaliers are valuable to the study.